Aashray urology institute

Penile Cancer

Overview
Penile cancer, or cancer of the penis, is when healthy cells change and grow out of control, forming a mass called a malignant tumor affecting the skin and tissues of the penis. At Aashray, different treatment options like surgeries, medications, therapies are offered to treat penile cancer. 
Penile Cancer Overview
Image Source: National Institute of Diabetes
and Digestive and Kidney Diseases, National
Institutes of Health.
Quick Links

What Is Penis ? 

The penis is an external genital male organ. The main functions of the penis are to pass urine and sperm out of the body. 

What Is Penile Cancer?

Penile cancer, or cancer of the penis, is when healthy cells change and grow out of control, forming a mass called a malignant tumor affecting the skin and tissues of the penis. A malignant tumor may eventually grow and spread to other parts of the body. There are also benign tumors of the penis that are non-cancerous. They may grow but do not spread to other parts of the body. Penile cancer is rare, but it can be treated if detected early. 

What Are The Types Of Penile Cancer ?

There are various types of penile cancer, including:

  1. Epidermoid/Squamous Cell Carcinoma:

    Squamous cell carcinoma usually begins on or under your foreskin but can also develop in other parts of your penis.

  2. Basal Cell Carcinoma:

    • Basal cells are found under the squamous cells in a layer of skin called the lower epidermis. Basal cell carcinoma begins deep in your skin. 

  3. Melanoma:

    Melanoma begins in melanocytes, which are melanin-producing cells located in the deepest layer of the epidermis. 

  4. Sarcoma:

    Sarcomas develop in the tissues such as blood vessels, muscles, and fat.

Types of penile cancer

What Are The Symptoms Of Penile Cancer?

People with penile cancer may or may not have all the symptoms and in some cases, one may have similar symptoms but for a different medical condition. So, it is to be noted that the symptoms are not a confirmation of cancer. The symptoms of penile cancer are as follow: 

  1. Presence of a lump, mass, or ulcer on the penis
  2. Changes in the skin color or thickness of the penis
  3. Persistent discharge with a foul odor underneath the foreskin
  4. A reddish, velvety rash under the foreskin
  5. Small, crusty bumps underneath the skin
  6. Swollen lymph nodes in the groin
  7. Pain in the shaft or tip of the penis

What Are The Causes And Risk Factors Of penile Cancer?

Following are the common causes and risk factors of penile cancer: 

  1. Older men, over age 60
  2. Smokers
  3. Body fluids that get trapped in the foreskin
  4. HPV (Human Papillomavirus), a sexually transmitted disease
  5. AIDS
  6. Men who aren’t circumcised
  7. Poor personal hygiene

How Penile Cancer Is Diagnosed?

Your doctor will recommend tests to diagnose penile cancer based on the factors like the suspected type of cancer, age, the overall health of the patient, signs, symptoms, and results of initial health checkups or medical tests. The tests are as follow: 

  1. Biopsy:

    In a biopsy, the doctor takes a small sample of tissue from the penis and sends it to the laboratory to check for cancer cells. It is the sure way to diagnose cancer.

  2. Lymph Node Biopsy:

    If your doctor believes that cancer has spread deep within the penis then nearby lymph nodes will be checked for cancer. This will help the doctor to determine the stage and grade of cancer.

  3. Imaging Tests:

    X-rays, CT scans, MRI, or other scans will be done to check if cancer has spread to other parts of the body.

What Are The Grades And Stages Of Penile Cancer?

Grades:

Penile cancers are also classified in terms of grade and those are determined by how cells looked under the microscope. To determine cancer’s grade, the doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually has many different types of cells grouped together. If cancer looks similar to healthy tissue and contains different cell groupings, it is called "differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." Higher grade penile cancers are more likely to spread to the lymph nodes and may need more intense treatment.

GX:

The tumor grade cannot be identified.

G1:

Describes cells that look more like healthy tissue cells, called well differentiated.

G2:

The cells are somewhat different from healthy cells, called moderately differentiated.

G3:

Describes tumor cells that look very different from healthy cells. This is called poorly differentiated or high grade.

TNM System for Penile Cancer:

Penile cancer is staged using the tumor node metastases (TNM) system.

  1. A tumor (T): How far has the primary tumor grown into the penis? Has it grown beyond the penis into nearby parts of the body, such as the pubic bone, scrotum, or prostate? 
  2. Node (N): Has the tumor spread to lymph nodes? If so, where and how many?
  3. Metastasis (M): Has cancer spread to other parts of the body or lymph nodes beyond the groin and pelvis? If so, where and how much?

1. A tumor (T) -

Using the TNM system, the "T" plus a letter and/or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A stage may also be divided into smaller groups that help describe the tumor in even more detail. This helps the doctor develop the best treatment plan for each patient. Specific tumor stage information is listed below:

  1. TX: The primary tumor cannot be evaluated.
  2. T0 (T plus zero): There is no evidence of a primary tumor in the penis.
  3. Tis: This stage is carcinoma in situ. An early, noninvasive precancerous growth. 
  4. Ta: This refers to a noninvasive squamous cell carcinoma located in only 1 area.
  5. T1: The tumor has grown into 1 or more outer layers of the penis. Depending on where on the penis the cancer is growing, these may include the lamina propria, the layer of skin called the dermis, the dartos fascia, or the connective tissue underneath the skin. This stage may also be divided into 2 substages based on the grade of the tumor and whether it has grown into blood vessels, lymph vessels, or nerves:
  1. T2: The tumor has grown into the corpus spongiosum, an internal chamber of the penis. It may or may not have grown into the urethra.
  2. T3: The tumor has grown into the corpora cavernosa, an internal chamber of the penis. It may or may not have grown into the urethra.
  3. T4: The tumor has grown into other nearby structures such as the pubic bone, the scrotum, or the prostate.

2. Node (N)-

The “N” in the TNM staging system stands for lymph nodes near cancer, called regional lymph nodes. The regional lymph nodes for penile cancer are located in the groin and the pelvis. Lymph nodes in other parts of the body are called distant lymph nodes. Staging places cancers that have spread to regional lymph nodes and cancers that have spread to distant lymph nodes in separate categories. The N in TNM staging only refers to the regional lymph nodes. 

If the doctor evaluates the lymph nodes before the biopsy or surgery, based on a physical examination and/or other tests, the letter “c”, for “clinical” staging, is placed in front of the N. If the doctor evaluates the lymph nodes after a biopsy or surgical removal of the lymph nodes, which is more accurate, the letter “p”, for “pathologic” staging, is placed in front of the N. The information below describes the pathologic staging.

  1. pNX: The regional lymph nodes cannot be evaluated.
  2. pN0: Cancer has not spread to the regional lymph nodes.
  3. pN1: Cancer has spread to 2 or fewer inguinal lymph nodes on the same side of the body. The inguinal lymph nodes are located in the groin.
  4. pN2: Cancer has spread to 3 or more inguinal lymph nodes on 1 or both sides of the body.
  5. pN3: Cancer has grown from the inguinal lymph nodes into the surrounding tissue in the groin, and/or cancer has spread to lymph nodes in the pelvis.

3. Metastasis (M)- The “M” in the TNM system describes whether cancer has spread from the penis to other parts of the body, called distant metastasis.

  1. M0: There is no distant metastasis.
  2. M1: There is metastasis to parts of the body other than the penis and the regional lymph nodes.

Cancer Stage Grouping: 

Doctors assign the stage of cancer by combining the T, N, and M classifications.

  1. Stage I: Low-grade cancer that has grown just below the surface layer of skin but not to nerves, lymph vessels, or blood vessels. It has not spread to lymph nodes or distant parts of the body (T1a, N0, M0).
  2. Stage IIA: The cancer is high grade or has grown into blood vessels, lymph vessels, or nerves. Or it has grown into the corpus spongiosum and may or may not have grown into the urethra. It has not spread to lymph nodes or distant parts of the body (T1b or T2; N0, M0).
  3. Stage IIB: Cancer has grown into the corpora cavernosum and may or may not have grown into the urethra. It has not spread to lymph nodes or distant parts of the body (T3, N0, M0).
  4. Stage IIIA: The tumor has not grown beyond the penis and urethra. It has spread to 1 to 2 groin lymph nodes but not to distant parts of the body (T1, T2, or T3; N1, M0).
  5. Stage IIIB: The tumor has not grown beyond the penis and urethra but has spread to 3 or more groin lymph nodes. It has not spread outside the groin lymph nodes, to the pelvic lymph nodes, or distant parts of the body (T1, T2, or T3; N2, M0).
  6. Stage IV: Any of the following:

What Treatment Options Are Available For Penile Cancer?

There are many treatment options available for penile cancer including:

  1. Medication:

    The doctor will recommend a skin cream if the tumor is on top of the skin.

  2. External Beam Radiation:

    This procedure is effective for the treatment of small lesions.

  3. Mohs Surgery:

    In case the lesion is bigger, but still about the size of a pea, then the doctor will recommend Mohs surgery. During this procedure, the affected skin is removed one layer at a time until healthy tissue is reached.

    mohs-surgery-treatment-for-penile-cancer1.jpg
  4. Cryosurgery:

    Also called cryotherapy or cryoablation. In this procedure, cold gases are passed through a metal probe through a small incision to freeze and destroy the tumor cells.

  5. Circumcision:

    This procedure is used when the cancer is only on the foreskin.

    penile-cancer-treatment-Circumcision
    Circumcision
  6. Penectomy:

    This is a surgery to remove some or all of your penis.

  7. Lymph Node Dissection:

    This surgery is used to remove some or all of the lymph nodes in your groin and/or pelvis.

  8. Radiation Therapy:

    In radiation therapy, high-energy rays or other such particles are used to destroy cancer cells and inhibit their growth. The following are the types of radiation therapy:

    1. External Beam Radiation Therapy: In this type of radiation therapy, external radiation from machines outside the body is given. 
    2. Internal Radiation Therapy: In this type of radiation therapy, devices are placed inside the body, or radiation is given using implants.

    Side-Effects of Radiation Therapy: 

    1. Fatigue
    2. Mild skin reactions
    3. Upset stomach
    4. Loose bowel movements
  9. Chemotherapy:

    In chemotherapy, medications are used to destroy the cancer cells, stop their growth as well as keeping them from dividing and developing new ones. Chemotherapy usually consists of a schedule in which a number of cycles or sets are repeated in a specific time period. There 2 types of chemotherapy and they are as follow:

    1. Topical Chemotherapy - In this type of chemotherapy, a catheter is inserted through the urethra to deliver the drugs to the bladder. However, in this therapy, drugs cannot reach tumor cells in the bladder wall or that have spread to other organs, so, they only destroy the superficial tumor cells.  
    2. Systemic Chemotherapy - Systemic chemotherapy is given directly into the bloodstream to reach cancer cells throughout the body. 

    Chemotherapy for penile cancer is generally given through an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

    After The Chemotherapy:

    Side-effects depend on the type of the drug, different combinations as well as the dose; however, the following are the general side-effects one may expect post-chemotherapy: 

    1. Fatigue 
    2. Risk of infection  
    3. Mouth sores
    4. Loss of appetite  
    5. Nausea and vomiting 
    6. Hair loss 
    7. Diarrhea

What To Expect During Follow-Up?

The follow-ups are especially important in cases of cancers to manage side-effects and monitor the overall health, recovery progress as well as check for any signs that cancer has come back. So, follow-up care and active monitoring are essential. These include regular physical examinations, medical tests, specific tests of the penis and the lymph nodes in the groin, chest x-rays or CT scans, and blood tests.

Cancer rehabilitation and survivorship care are recommended, and this could mean any of a wide range of services that help people regain control over many aspects of their lives and remain as independent and productive as possible and these services may include physical therapy, career counseling, pain management, nutritional planning, financial counseling, and/or emotional counseling.

Book Appointment

If you have any questions or doubts about any treatment for Penile Cancer or any other treatment available at Aashray Urology Institute, book a consultation with Dr. Ashit Shah and he will expertly guide you on the same. 
Book Appointment
Dr. Ashit Shah

Dr. Ashit Shah

Meet the doctor

Dr. Ashit Shah

MB, MS, DNB(Urology), DLU(France)

Dr. Ashit Shah

Dr. Ashit Shah

Dr. Ashit Shah is a senior consultant Urologist heading Aashray Urology Institute. After completing his M.B.B.S. and M.S. in General Surgery, he was awarded Diplomate of National Board (D.N.B.) in Genito-Urinary Surgery by the National Board of Examinations, New Delhi. He earned his Diplomate in Laparoscopic Urology from Louis Pasteur University, Strasbourg, France in the year 2006. Dr. Shah has a special interest in Endo-Urology, especially Urolithiasis i.e. Urinary Stone Disease. Having spent more than 27 years in the profession of Urology, he has experience of over 75,000 urological consultations and more than 15,000 surgeries. Being counted amongst the torch bearers of ethical and transparent medical practice in the city of Vadodara, he was conferred ‘Inspiring Urologist Award’ for the year 2019 by The Economic Times.

Insurance Partners

To see the complete list of our insurance partners, click here.